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L.L. Francu, Dorelia Lucia Calin
74
Vol. XI Nr. 1 2012 CLINICAL ANATOMY
Revista Românã de Anatomie funcþionalã ºi clinicã, macro- ºi microscopicã ºi de Antropologie
LINGUAL PIERCING: DENTAL ANATOMICAL CHANGES
INDUCED BY TRAUMA AND ABRASION
L.L. Francu1, Dorelia Lucia Calin2
University of Medicine ºi Pharmacy Gr.T. Popa Iasi
1. Discipline of Anatomy
2. Discipline of Cariology and Restorative Odontotherapy
LINGUAL PIERCING: DENTAL ANATOMICAL CHANGES INDUCED BY TRAUMA AND
ABRASION (Abstract): Rising popularity of lingual piercing among young people alarm doctors
everywhere. The tongue is the most prevalent oral piercing site, typically pierced in the midline
and just anterior to the lingual frenum. The purpose of this study to highlight the side effects of
lingual piercing, paying particular attention to dental anatomy changes pursuant to this unusual
practice. The evaluated patients in this study were not aware or informed of any consequences that
could result from the piercing procedure. Long-term chronic complications arise as a result of the
constant trauma exerted by the metal bar, such as broken teeth, fracture of fillings, abrasion,
gingival trauma, localized gingival recession. Dentists should be aware of the sequelae that may
occur as a result of this practice and to perform an active role in convincing these patients to
remove these ornaments. Key words: LINGUAL PIERCING, PIERCING COMPLICATIONS,
TOOTH ABRASION, TONGUE ORNAMENTS
INTRODUCTION
Body piercing has been practiced since an-
cient times (1), religious, ritual or other rea-
sons. In the Aztec and Maya cultures, tongue
piercing for ritual purposes was performed by
priests and there are many illustrations in this
respect. For the Eskimos was a purification
ritual.
In modern society, those who resort to wear-
ing these types of ornaments feel the need to be
remarked, to make a personal statement, to
enhance sexual appeal, feel a need for social
distinction or use it as a spiritual practice, but
the most common reason invoked is that of
aesthetic (2).
Rising popularity of lingual piercing among
young people alarm doctors everywhere. Nowa-
days, lingual piercing has an increased risk of
carrying infections: HIV, hepatitis B and C,
herpes simplex, Epstein-Barr virus, Candida,
Ludwigs angina (3). In addition, dentists are
facing a growing number of patients that pre-
sent oral tissue piercings, such as lips, cheeks,
tongue or uvula (4).
Due to the increasingly frequent use of these
jewels, dentists face many complications and
associated risks, including the development of
many types of microorganisms, persistent blee-
ding, hematoma, because the tongue is a much
vascularized organ. They must detect these le-
sions and inform patients about the risk of this
practice.
For these reasons, some dentists are skep-
tical about the application of lingual piercing.
The tongue is the most prevalent oral piercing
site, typically pierced in the midline and just
anterior to the lingual frenum (5). The used
jewels are made of different materials such as:
surgical stainless steel, chrome-cobalt alloys,
nickel, copper, brass, silver, gold, platinum,
titanium and niobium, and more recently syn-
thetic materials such as plastic, PMMA (poly-
methylmethacrylate) or PTFE (polytetrafluo-
retilen). They can also be made of natural
materials such as bone, horn, ivory, wood, and
stone (6).
The lingual piercing generally used in the
tongue consists of a stud with two balls screwed
Lingual Piercing: Dental Anatomical Changes Induced by Trauma and Abrasion
75
to each end. It is inserted in the central, thick-
est area of the tongue, avoiding the lingual fre-
num and vascular and nerve packages. The bar
size is greater than the thickness of the tongue,
allowing its movement (7).
The purpose of this study to highlight the
side effects of lingual piercing, paying particu-
lar attention to dental anatomy changes pursu-
ant to this unusual practice. At the same time,
we want to warn both dental practitioners and
devotees of this practice on the oral health con-
sequences, even if performing this procedure
is a personal decision.
MATERIALS AND METHODS
It was examined a group of 165 patients
who presented to consult to the Department of
Cariology and Restorative Odontotherapy, Uni-
versity of Medicine ºi Pharmacy Gr. T. Popa
Iaºi. None of the patients did not attend the
expert advice of the immediate complications
of piercing procedure.
The participants in this study were evalu-
ated by a single examiner who used the same
methodology for assessing the lesions. Intraoral
examination of patients was performed visually
using a dental mirror; a special attention was
paid to dental complications caused by the
piercing procedure.
Clinical examination showed the presence
of lingual piercing (fig. 1 and fig. 2) as stud
with two threaded balls at each end on the
dorsal and ventral surface of the tongue.
It was recorded dental pathology related to
the presence of lingual piercing. We will then
discuss the changes of dental anatomy caused
by tongue piercing exemplifying the significant
cases.
RESULTS
The evaluated patients in this study were
not aware or informed of any consequences
that could result from the piercing procedure.
Lack of information on the complications can
be attributed to the fact that these procedures
are performed by persons not belonging to the
the medical profession, unlicensed who may
not have sufficient clinical and anatomic knowl-
edge or who prefer not to inform patients in
order not to scare and remove them.
A significant correlation was observed be-
tween the presence of a tongue piercing and a
higher incidence of enamel cracks, enamel frac-
tures (especially of the incisal edge of anterior
teeth). These injuries were caused by repeated
hitting of the device balls against the teeth dur-
ing chewing or speaking.
There have been detected abrasion lesions
of the incisal edge of upper incisors due to
intentional interposition of the device between
the upper and lower front teeth (Fig. 3).
DENTAL ANATOMICAL LESIONS
DETERMINED BY LINGUAL
PIERCING
Due to growing popularity of this practice,
especially among adolescents and young adults,
the dentists are facing many oral and dental
complications and associated risks. They must
detect these lesions and should inform patients.
Tongue piercing is associated with numer-
ous complications.
A systematic classification of the side ef-
fects of tongue piercing allows three types of
complication to be distinguished (8): compli-
cations during piercing procedure, immediate
postoperative complications following piercing
and long-term complications.
The complications that can occur during the
procedure are lesions of vascular packages,
bleeding, nerve damage, and paresthesia.
The immediate post-operative complications
are acute, occur after piercing and affect the
soft tissues: swollen tongue, which lead to mas-
tication difficulties, speaking, breathing (9),
infection, and hematoma. Hypersensitivity re-
actions, known as allergic contact dermatitis,
to the metal when jeweler is not of the best
quality or contains nickel may occur (10), for-
eign body reactions or generation of a gal-
vanic current between metal dental fillings and
jewelry (2).
DENTAL COMPLICATIONS
Long-term chronic complications arise as a
result of the constant trauma exerted by the
metal bar, such as broken teeth, fracture of
fillings, abrasion, gingival trauma, localized
gingival recession (11), gingival overgrowth,
bifid tongue (12), swallowing or inhaling of the
device or its parts (13).
The gingival recession can be caused by
lingual piercing, it occurs especially on the
lingual surface of the mandibular anterior teeth.
L.L. Francu, Dorelia Lucia Calin
76
The gingival recession develops as a narrow
cleft-like defect on the lingual surface of the
mandibular incisors, with a depth of 2-3 mm
and often extending to or beyond muco-gingival
junction (5).
The dental complications occur and as a a
result of vicious habits or tendency of patients
to play with the jewelry. Holding the device
between the teeth over an extended period of
time can lead to a widening of the interdental
spaces and tooth migration (14). It was re-
ported the occurrence of midline diastema af-
ter a period of 3-4 years after installation of the
device, the patients managed to pass all bar
between central incisors (15).
Tongue piercings may result in abnormal
tooth wear. Biting or chewing of the device can
lead to severe abrasion of the healthy teeth
(16). Abrasion may be accompanied by hyper-
sensitivity. Dental injuries can be confined to
the enamel, dentin, but may determine the pulp
involvement (17). Dental injuries can occur in
one year from the application of jewelry (18).
Prosthetic porcelain works can fracture in
patients with lingual piercing because porce-
lain is brittle and has a low resistance to impact
(19). Thus, patients should be advised to re-
move the oral jeweler permanently or to re-
place metal balls with non-metallic ones.
And people who wear orthodontic appli-
ances need to know that a lingual piercing af-
fect them leading to their breakdown and dam-
age to teeth and gums due to contact with the
device.
CONCLUSIONS
1. The presence of lingual piercing involves
the risk of direct and indirect damage of
hard oral tissues.
2. Tongue piercings may result in abnormal
tooth wear (groove-shaped abrasion).
3. Patients are not aware or informed of any
consequences that may result from the pierc-
ing procedure.
4. Dentists should be aware of the sequelae
that may occur as a result of this practice
and to perform an active role in convincing
these patients to remove these ornaments.
5. Subjects who already have a tongue pierc-
ing should be informed about the risks and
complications of that are exposed.
Fig. 1. Patient of 21 years with lingual piercing. Fig. 2. Patient of 21 years with tongue piercing.
Fig. 3. Abrasion lesion of incisal edge of the
upper central incisor with the destruction of
incisal angle due to intentional interposition of
the device between the upper and lower front
teeth (groove-shaped abrasion).
Lingual Piercing: Dental Anatomical Changes Induced by Trauma and Abrasion
77
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